What Patients Should Know
From pulsed light therapy to eyelid massage, people with dry eyes have a sea of options to navigate. An eye expert breaks down 12 of the latest technologies for relieving dry eyes.
Written By: Reena Mukamal Shared from the American Academy of Ophthalmology
Many people experience red, irritated eyes at some point, perhaps after hiking on a windy day or socializing at a party filled with cigarette smoke. Dry eye is commonly treated with warm compresses or over-the-counter eye drops called artificial tears.
But when your eyes feel dry and gritty every day — as a result of aging, underlying health conditions, certain prescription drugs or long hours staring at a computer screen — your doctor may suggest a stronger treatment. A traditional treatment involves placing tiny devices called punctal plugs into your tear ducts to keep your natural tears in your eye.
Today, there are a growing number of device-based therapies that help target the root causes of dryness. Here’s a rundown of the latest technology used by ophthalmologists and other eye care providers to help soothe dry eyes.
‘Deep cleaning’ devices for dry eyes
Dry eye discomfort often stems from blockages in the tiny oil glands along the edge of your eyelids. These so-called meibomian glands give your tears a protective oily layer called meibum. Meibum keeps your tears from drying too quickly. But in patients with dry eye, meibum can thicken and clog the glands.
“Taking care of dry eye is like taking care of your teeth,” says ophthalmologist and Academy spokesperson Mitchell Jackson, MD. “Brushing and flossing at home will help you maintain good oral hygiene, but by itself it’s not enough. You still need to go to the dentist every 6 to 12 months for a thorough removal of dental plaque. For the eyes, you need daily lubrication and warm compression at home, and you should also fully clean out the meibomian glands from time to time.”
Dr. Jackson described a few devices that eye care providers can use to deep clean these glands:
- Lipiflow (Johnson & Johnson Vision). Shell-shaped applicators are placed over the front and back of each eyelid. A computer delivers heat and pressure to the applicators to massage the meibomian glands and release clogged oils. Patients receive numbing eyedrops before treatment. Studies suggest LipiFlow reduces dry eye symptoms for six months to a year, with minimal side effects. Some patients experience minor eye redness that goes away after treatment. Because of the applicator shape, this device may not be ideal for patients who have deep-set eyes. This was the first pulsed heat device approved by the U.S. Food and Drug Administration to treat meibomian gland dysfunction and is considered a gold standard. It is also the most expensive treatment, costing about $900 per session.
- TearCare (Sight Sciences). Similar to Lipiflow, this device applies heat to the meibomian glands using an applicator placed over each eyelid. TearCare’s applicators are made from a thin, flexible material that allows patients to keep their eyes open and blink during treatment. Numbing drops are not necessary. Your eyecare provider may need to massage your lids after the heat is applied to completely release clogged oils. This treatment is appropriate for all eye shapes and sizes. One session costs between $600 and $700.
- iLux (Alcon). Eyecare providers can use this handheld, portable device to heat and massage the eyelids. LED-based heat and gentle pressure work together to release clogged oils. This device is best used to spot-treat problems on individual eyelids. Patients can expect results comparable with LipiFlow and TearCare, with the cost of treatment similar to TearCare. Patients who wear face masks all day, every day, to prevent COVID-19 have a tendency to develop clogged oil glands (called chalazia) in the eyelids. This treatment can help.
- Mibo Thermoflo (Mibo Medical Group). A cross between Lipiflow and iLux, this system includes a power console, wired handpiece and metal eye pads placed over the eyelids. The console provides heat while an eyecare provider manually massages the pads over the eyelids to release clogs in the meibomian glands. This device may require more frequent treatments than either Lipiflow or iLux. The cost of this therapy ranges between $100 and $400.
- EyeXPress (Holbar Medical Products). Your doctor will cover your eyes with goggles that contain a soft gel insert attached to a heating device. The goggles fit over your eyelids and are warmed to soften your meibum. Your provider will then massage your eyelids to release the oils. This therapy requires patients to have four treatments scheduled three to four weeks apart. Sessions cost between $450 and $750.
- NuLids (NuSight Medical). Your ophthalmologist might recommend this portable, handheld system for home use to massage and clean your eyelids. The machine uses a disposable tip made of soft silicone together with cleanser for a daily, one-minute treatment. The device costs about $300 and comes with a 30-day supply of tips.
- BlephEx (BlephEx LLC). This handheld device rotates a medical-grade sponge at high speeds to remove excess bacteria, biofilm and toxins from the eyelids and outer meibomian glands. It can be helpful in managing both swollen eyelids (called blepharitis) and meibomian gland blockages. Sometimes BlephEx is used right before, or along with, one of the heat-based treatments mentioned above. Other patients find that it works well as a standalone maintenance treatment four times per year. The procedure takes about eight minutes and costs $150 per session.
- Intense Pulsed Light Therapy (various companies). Intense pulsed light therapy has been FDA-approved for more than 15 years to treat rosacea, remove skin lesions and address other skin problems. It is also used off-label to treat meibomian gland blockages. During a session, infrared light is applied directly to the eyelids with a handheld device. The light helps reduce inflammation and loosen up clogged meibomian gland blockages. This therapy is not suitable for people with darker/pigmented skin. Treatments take 10 minutes and need to be repeated four times per year. Intense pulsed light therapy costs about $400 per session.
- ITN TrueTear (Allergan). This treatment is administered through the nose rather than the eyes. The device uses two tiny probes, one placed in each nostril. The probes deliver small electrical currents to stimulate the nerves lining the inside of your nose. This triggers the brain to increase tear production via your lacrimal glands. TrueTear is mainly used for patients with certain type of meibomian gland dysfunction known as “aqueous deficient.” Patients can perform the treatment on themselves four times per day for 30 to 60 seconds each. Sometimes the treatment can cause discomfort and burning inside the nose, nosebleeds or headaches. The device can’t be used in patients who have pacemakers or wear defibrillators. TrueTear costs $650 for the device, charger and one month’s supply of tips. A similar device called the iTEAR 100 is available from Olympic Ophthalmics.
Specialty contact lenses that heal the eye’s surface
Patients with moderate-to-severe dry eye may experience lasting damage to your eyes’ clear dome, or cornea. Specialty contact lenses (called scleral lenses) can help repair the surface of the eyes and are mainly used in patients with severe meibomian gland dysfunction.
- Prokera (BioTissue, Inc). This futuristic lens uses a piece of donated amniotic tissue that is held in place over the cornea with a small ring. Wearing it feels like having a very large contact lens in your eye. The tissue, which comes from a placenta, heals the cornea. Patients usually wear the lens for three days. Studies have shown that Prokera can keep severely dry eyes comfortable for months after removal. Prokera is also used to treat keratitis, corneal scars, chemical burns and other eye diseases that cause inflammation. It may be covered by insurance, depending on your plan.
- BostonSight Prosthetic Replacement of the Ocular Surface Ecosystem, or PROSE (Boston Foundation for Sight). This custom designed and fitted lens is a treatment reserved for patients with the most severe cases of dry eye, who have tried other treatments with limited success. The lens is placed on the white part of your eye, called the sclera, to create a smooth covering over the eye’s damaged surface. The lens is filled with preservative-free saline each day and is removed at bedtime. PROSE is extremely expensive and hard to find, as it’s only offered by 12 eyecare institutions today.
- EyePrintPro (EyePrint Prosthetics, LLC). This prosthetic lens takes an imprint of the ocular surface and converts it into a digital 3D model, which is then printed as a new lens. The EyePrintPro uses a much faster process than the PROSE to custom-fit your unique cornea and sclera. For that reason, the device is much less expensive and costs about $4,000.
“We’ve come a long way with dry eye strategies and treatments,” says Dr. Jackson. “In addition to all of these technologies, there are 38 FDA clinical trials currently underway for even more innovative products.
All of this should offer hope to patients. If you have mild, moderate or even very severe dry eye disease, there is likely a treatment for you. To best meet your needs, it’s important to first see an eye care professional for a comprehensive examination.”
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